The Interim has tried to keep abreast of the growing strength of the ‘Dying with Dignity’ movement (See, for example, the articles “Doctors hear euthanasia warning” and “Dying with Dignity recommends that right to kill,” in our June 1989 issue).
For November 1989 till March 1990, The Interim published four lengthy articles by Charles Eckman on the threat of active euthanasia and the predicaments of health personnel in difficult cases.
From these articles it became clear that the question of food and fluids for patients in irreversible coma had not been settled.
As yet, even the Roman Catholic Church has not issued definitive guidelines about what to do in such cases.
Declaration on Euthanasia
In 1980, the Vatican’s Congregation for the Doctine of the Faith issued a Declaration on Euthanasia. This concerned the value of human life, the meaning of suffering for Christians, the use of pain-killers and the need for due proportion in the use of medical remedies.
Toward the end of the eighties, rumours from Rome had it that the Vatican was weighing the question of comatose patients. No document has been forthcoming, however. Hence, theologians continue to weigh the pros and cons of treating comatose patients.
Food and fluids
In the meantime, the bishops’ conferences of Texas, Florida, New Jersey and now Missouri have felt it necessary over the last few years to issue statements. While united in their rejection of euthanasia, they differ in emphasis on withdrawing food and fluids.
The bishops of New Jersey took a dim view of this sort of ‘treatment’ in a 1986 court intervenor’s brief. So did the bishops of Maryland in a 1988 letter.
In April 1989 the bishops of Florida stated in part:
“”The strongest presumption must be given to continuing artificial sustenance. While the benefit is greatly reduced due to the lack of consciousness, human life itself is a good, and the life of comatose persons must be accorded respect.
“By the same token, the burdens of this treatment are limited, there being no or very little pain, discomfort or psychological repugnance. The cost of artificial nutrition and hydration is usually minimal, not much more than the cost of ordinary feeding.
“Thus, we can say as a general rule that artificial sustenance should not be withheld or withdrawn from these patients.”
Burdens to the patient
In June 1990, sixteen of 18 bishops in Texas came up with a difference emphasis. In their “interim pastoral statement,” the 16 bishops argued that food and fluids may be cut off whenever the burdens to the patient, the family or society outweigh the benefits.
This view seemed to contradict the many ethicists who hold that withdrawing food and fluids should occur only when comatose patients themselves are dying or near death, that is if the feeding itself has become burdensome to them.
The Texas statement, written in response to requests from hospitals, widens the emphasis from the patient only to one that includes family and society.
Examples the bishops indicate of disproportionate burdens are “excessive” suffering for the patient, “excessive” expense for the family or the community, use of medical technology and personnel “disproportionate” to expected results, and “inequitable” allocation of resources.
None of these categories is further defined.
Arguing that food and fluids can then be withdrawn, the document says there is “no moral obligation under these circumstances to impede the normal consequences of the underlying pathology.” The physical cause of death, it asserts, is “ultimately the pathology” rather than refusing food and water.
Bishop Rene Gracida
Two of Texas’ 18 bishops refused to support the declaration. One has remained anonymous; the other is Bishop Rene Gracida of Corpus Christi who in the diocesan newspaper called the statement “seriously flawed.” He stated:
“I would have preferred to see my fellow bishops of Texas issue a document which would have made a stronger statement in support of the sick person’s right to receive food and drink as the basic necessities of life.”
In his argument, Bishop Gracida sided with Bishop James T., Hugh of Camden, N.J., a former director of the U.S. bishops’ national pro-life office who is now a member of the NCCB Committee for Pro-Life Activities.
In a 1989 interim paper, Bishop McHugh had supported the more cautious view of the Florida bishops. Stated Bishop McHugh:
“[A] “more convincing approach” holds that ‘food and water are not primarily forms of therapeutic medical treatment (but) basic means of sustaining life without which anyone will die’
“Thus nutrition and hydration should be provided as part of a patient’s normal care, even if provision of such care requires medical technology, unless or until the benefits of nutrition and hydration are clearly outweighed by a definite danger or burden, or they are clearly useless in sustaining life.
“Artificially assisted nutrition and hydration are not customarily burdensome because they are commonplace medical technologies, not overly expensive, and can generally be monitored by trained persons, including family members.
“They do not usually increase the suffering of the patient. They are not useless in that they sustain the life of a person who is alive but impaired in terms of function. They provide the basic nourishment necessary for life, and maintain a bond of solidarity between caretakers and the helpless person who is dependent upon them.”
In other words, one group sees the administering of food and water to comatose patients as a form of ‘medical treatment’, hence a therapy that can be given or withheld.
Others see it as so basic to life that it doesn’t deserve that name of ‘treatment’.
It should never be refused.
In fact, it is difficult to see what the Missouri bishops intended, other than to express the hope that people of goodwill who have God’s law in mind should be trusted to do the right thing eventually.